I haven't been posting much on this blog as I've been very busy with other things over the past few months. Now that I have a bit more time, I am going to be looking over the various pages on the main Blood Sugar 101 web site and bringing them up to date.
I post all significant changes to the main web site on the Changes to Blood Sugar 101 blog, which makes it easy to keep up with them.
If you have any ideas about how to improve the main web site, or any topics you feel should get more coverage, please mention them in a comment on this post. However, keep in mind that there are already over 100,000 words posted on this site and its blog so the challenge with this web site is to keep it from becoming so overwhelming that the people who come to it for the first time don't miss the important information I'd like them to take away from it.
The focus needs to remain on explaining to people what blood sugar levels are normal, what levels cause diabetic complications, and what strategies safely lower blood sugar and prevent complications.
My web stats show me what pages on the site people actually visit, and for now, it is the pages that stick to that core mission that receive the heaviest traffic. The rest of the site, as fascinating as it might be, rarely gets visited. So the only changes I'm really interested in making are those that will make the pages that convey this vital information even more useful.
November 4, 2012
October 12, 2012
Final Update: My Experimental Diet
I continued eating a very low carb, very low calorie, gluten-free diet that matched the parameters set by my nutritional calculator though last Sunday, but I waited to report on the outcome until my glycogen had refilled. That would make clearer what the real impact of the diet had been.
I also went to the lab last Thursday as it was time for my semiannual visit to the endo, which gave me more insight into what changes the diet had made in my health.
Nutritional Breakdown
Here is what I ate during the second week of my diet. As you can see it was only slightly higher than the intake the previous week. Salt was well controlled and protein was slightly higher than recommended for someone on a long term low carb diet, but lower than that for someone not at all adapted to ketosis*:
Impact on Weight
I had set my calories at the brutally low level that the nutritional calculator predicted should yield a weight loss of 1 lb a week. The level was low because I am old and short, and because I started out at a normal weight. Since it only takes about 1,560 calories to maintain my current weight, the nutritional theories I lay out in my Diet 101 book, which are embodied in the calculator, predict I would have to eat no more than 1,060 calories a day for a week to lose a pound of real fat.
Before starting the diet my weight had been hovering around 146.5 lbs, however, it was 148 lbs the day I started the diet thanks to the very salty Vietnamese lunch I'd had the day before with it's miso-based soup and soy-sauce based sauce. I always gain 2 or 3 lbs after eating a soy-sauce laden meal.
My weight on Monday morning after 2 weeks on my diet was 141.2. This was a loss of scale weight of 6.8 pounds, but because I was eating less than 20 grams of carbs all week, I knew that a good 3 lbs or more of my weight loss was due to the loss of glycogen, which is the substance our body uses to store glucose in both our livers and our muscles. (Details about glycogen-related weight loss HERE.)
I had stopped taking my metformin in the middle of the first week as metformin does interesting things to glycogen and I wanted my diet trial to be cleaner. So after 10 days without metformin and 14 without carbs, I figured I'd probably flushed out as much glycogen as I was going to lose. In the past that was usually about 3 lbs.
Since glycogen comes back as soon as you raise your carbs I expected to see the 3 lbs come back within a few days after ending my diet and raising my carbs back to their usual level which is around 100 g a day.
I also expected that some of my weight loss was due to the fact that since I was eating so little to meet my caloric goal there was less weight of food in my stomach and gut. That too would come back.
Since this past Monday, I have started using metformin again and eating about 100 grams of carbs a day, while eating a maintenance diet. My glycogen is probably as refilled as it's going to get. My weight this morning was 144.6. This is almost exactly 2 lbs less than my average weight during the weeks before I started the diet.
This confirms that my nutritional calculator does a good job of predicting weight loss and, most importantly, that there is no "metabolic advantage" for me in eating a very low carb diet. I did not lose any more weight than would be predicted by caloric deficit.
Had I been in a study, however, my specious loss of 6.8 lbs might have made it look like there was an advantage to eating a very low carb diet since low fat diets don't always flush out glycogen and the food may weigh more.
Unfortunately, it looks like, as usual, the weight came off my face and neck which look more wrinkly and stringy than usual. My tummy, which is the only place I carry significant amounts of subcutaneous fat, doesn't seem any smaller. The Tanita readings are fluctuating so much that I'll have to wait another week or so to see if they show any substantive loss of body fat percentage.
Blood Pressure
My two week diet was designed to be low in salt, because it is too easy to eat a lot of salt while eating a classic LC diet and I have issues with my blood pressure. I bought low salt cold cuts without preservatives at Trader Joe's and stuck with cheeses that were lower in salt, too. No pork rinds or other salty low carb snacks!
My blood pressure was all over the place during my diet, high and normal an then high again. When I started to cautiously supplement with potassium chloride (in the form of Morton's Not Salt) it dropped to completely normal and stayed that way for the last few days of the diet.
I was supplementing with the potassium because I get leg cramps and palpitations when I eat very low carb without potassium. This is because flushing out glycogen also triggers a loss of potassium. (This loss is measured in some studies as a rough gauge of how much glycogen has been lost.)
My lab results from last Wednesday when my blood pressure was 122/73 showed that my blood sodium level was at the very bottom of the normal range and potassium was in the middle of the normal range. This was reassuring, as I had a concern that the Captopril I take might cause my potassium levels to rise too high. I was not dehydrated, based on my normal BUN. In the past when eating LC I have almost always had a high BUN. Controlling protein might have helped there as did the potassium.
When I ended my diet and went back to eating normally, my blood pressure soared. As a further experiment I went back to supplementing with potassium, thanks to the suggestion one of you sent me, and today my blood pressure is back to being normal, at 114/74, as opposed to the 151/92 it was three days ago.
Since I had a lot of trouble with very high blood pressure while eating a very low carb diet in the past--the exact opposite of what the LC gurus claim happens--I'm starting to think that BP for me is all about those potassium levels. Low carb diets can be very high in sodium and potassium deficient, and that may be why I had so much trouble with blood pressure eating a long-term low carb diet.
Blood Sugar
My blood sugars had continued to be beautiful--in the 70s and low 80s at all times. So it was daunting to discover that the lab said my blood sugar was 92 mg/dl when my meter said it was 83 mg/dl. This means that the FreeStyle Lite meter that my insurer forces me to use reads low. So it's probable that my 70s were really 80s and 80s were 90s. It also means my occasional 140s were probably really 150s.
My A1c was 5.5%, which is .2% lower than usual. Some of the drop is due to the low carbing I'd done during the previous 2 weeks. Though doctors think that the A1c reflects the control of the last 3 months, this is not entirely true. The A1c most strongly reflects the blood sugar control during the previous 2 weeks, with the rest of the past experience only making a smaller contribution.
My A1cs are always higher than predicted by my average meter readings, and this one is no different. I attribute this to the likelihood that my red blood cells are living longer than average which will raise how much glucose has become bonded to them. It is that, not actual blood sugar levels, that the A1c measures.
Mood and Energy
By the end of my diet I felt like absolute crap. I wasn't sleeping well and was having the vibrant dreams that happen early on in a ketogenic diet, but there was no sign of the energy burst I usually experience at that phase of an low carb diet. This may be a result of how low my calories had to be for me to lose weight.
Whatever the explanation, I felt exhausted and depressed, and just walking around was a challenge. As soon as my diet was complete and I raised my carbs back to their usual level I felt like my old self with much better energy.
I was very hungry throughout the last week, too, even though my fat intake was reasonably high and my blood sugars completely flat.
Because my blood sugars are very well controlled right now I did not get into binging once I stopped my diet and started eating carbs again. In fact, I had a couple days when I was very busy with a new project over the past few days where I didn't end up eating all that much. This verified my belief that, for me, when I am eating carbs, hunger is entirely about how high my blood sugars surge. Right now they aren't surging very high even when I eat 20-30 g of carbs per meal, so I'm not experiencing blood sugar-caused hunger.
In the past eating a very low carb diet for a few weeks has given me decent energy and no hunger, but I wasn't limiting calories. However, throughout the past 5 years when I've done a very low carb diet not counting calories, I haven't lost an ounce of real weight.
Miscellaneous Observations
I ended up having a lot of heartburn on this diet. Peanut butter and Greek yogurt both caused it. Cheese did not (ruling out that I'm sensitive to dairy, per se.) When I went back to eating gluten at the end of the diet I did not experience heartburn. There doesn't seem to be any reason for me to go gluten free.
Conclusions
Calories count. My nutritional calculator is pretty accurate. It is extremely hard to find low carb foods that meet the caloric target I have to hit to lose weight without boosting protein too high.
This diet confirmed that for me to lose any weight at my age (64) and size (5' 3 and 144 lbs) I'd have to eat no more than 1250 calories a day to lose 2 lbs a month, even on a low carb diet, which for me would be an unsustainable starvation diet.
So my conclusion is that my weight loss diet days are over and that now that I'm heading into my misnamed "golden years" I better get used to carrying a bit more weight because the alternative is a starvation lifestyle.
Fortunately, there is a solid body of research suggesting that the healthiest weight for people my age and older skews towards the "overweight" category (BMI of 25 and a bit higher).
What this may mean for you is that the time to lose weight is when you are in your 30s, 40s, and 50s, when you burn more calories just breathing and walking around. Our metabolic rate drops with each decade we survive--even with exercise--so it gets tougher to lose weight as we get older.
Low carb diets are very effective for people with a lot of weight to lose whose caloric needs are much higher, but their main advantage in respect to weight loss is that when people cut out carbs they cut out all the high caloric junk that is what caused them to gain weight in the first place. If you control protein it becomes much tougher to overeat on a low carb diet, too.
The true virtue of low carb diets is, of course, that they control blood sugar very well. If my current blood sugar-control regimen stops working, I know that cutting back on carbs will drop my blood sugar (as long as I have functional beta cells, which fortunately, seems to be the case.)
Comments?
NOTE: In response to a point brought up in one of the comments it's worth noting that after Thanksgiving I did 10 days of a classic "Don't count anything but carbs" diet. In contrast to what happened with the calorie controlled low carb diet described above, I lost a grand total of 2 lbs during the "all you can eat" LC diet which came back when I raised carbs out of the ketogenic range. I was spilling urinary ketones from day 3 to day 10. Blood sugar and blood pressure were normal on that diet (after a rocky first few days for the blood pressure, again) but as has been the case for me for the past 5 years, a ketogenic low carb diet without caloric restriction is worthless for weight loss.
-----
* I used the body fat percentage my Tanita scale provides when using the calculator to estimate intake. If I omitted the body fat percentage, the calculator would tell me that I would have to eat a starvation diet to lose 1 lb a week, which it won't provide numbers for.
I also went to the lab last Thursday as it was time for my semiannual visit to the endo, which gave me more insight into what changes the diet had made in my health.
Nutritional Breakdown
Here is what I ate during the second week of my diet. As you can see it was only slightly higher than the intake the previous week. Salt was well controlled and protein was slightly higher than recommended for someone on a long term low carb diet, but lower than that for someone not at all adapted to ketosis*:
Impact on Weight
I had set my calories at the brutally low level that the nutritional calculator predicted should yield a weight loss of 1 lb a week. The level was low because I am old and short, and because I started out at a normal weight. Since it only takes about 1,560 calories to maintain my current weight, the nutritional theories I lay out in my Diet 101 book, which are embodied in the calculator, predict I would have to eat no more than 1,060 calories a day for a week to lose a pound of real fat.
Before starting the diet my weight had been hovering around 146.5 lbs, however, it was 148 lbs the day I started the diet thanks to the very salty Vietnamese lunch I'd had the day before with it's miso-based soup and soy-sauce based sauce. I always gain 2 or 3 lbs after eating a soy-sauce laden meal.
My weight on Monday morning after 2 weeks on my diet was 141.2. This was a loss of scale weight of 6.8 pounds, but because I was eating less than 20 grams of carbs all week, I knew that a good 3 lbs or more of my weight loss was due to the loss of glycogen, which is the substance our body uses to store glucose in both our livers and our muscles. (Details about glycogen-related weight loss HERE.)
I had stopped taking my metformin in the middle of the first week as metformin does interesting things to glycogen and I wanted my diet trial to be cleaner. So after 10 days without metformin and 14 without carbs, I figured I'd probably flushed out as much glycogen as I was going to lose. In the past that was usually about 3 lbs.
Since glycogen comes back as soon as you raise your carbs I expected to see the 3 lbs come back within a few days after ending my diet and raising my carbs back to their usual level which is around 100 g a day.
I also expected that some of my weight loss was due to the fact that since I was eating so little to meet my caloric goal there was less weight of food in my stomach and gut. That too would come back.
Since this past Monday, I have started using metformin again and eating about 100 grams of carbs a day, while eating a maintenance diet. My glycogen is probably as refilled as it's going to get. My weight this morning was 144.6. This is almost exactly 2 lbs less than my average weight during the weeks before I started the diet.
This confirms that my nutritional calculator does a good job of predicting weight loss and, most importantly, that there is no "metabolic advantage" for me in eating a very low carb diet. I did not lose any more weight than would be predicted by caloric deficit.
Had I been in a study, however, my specious loss of 6.8 lbs might have made it look like there was an advantage to eating a very low carb diet since low fat diets don't always flush out glycogen and the food may weigh more.
Unfortunately, it looks like, as usual, the weight came off my face and neck which look more wrinkly and stringy than usual. My tummy, which is the only place I carry significant amounts of subcutaneous fat, doesn't seem any smaller. The Tanita readings are fluctuating so much that I'll have to wait another week or so to see if they show any substantive loss of body fat percentage.
Blood Pressure
My two week diet was designed to be low in salt, because it is too easy to eat a lot of salt while eating a classic LC diet and I have issues with my blood pressure. I bought low salt cold cuts without preservatives at Trader Joe's and stuck with cheeses that were lower in salt, too. No pork rinds or other salty low carb snacks!
My blood pressure was all over the place during my diet, high and normal an then high again. When I started to cautiously supplement with potassium chloride (in the form of Morton's Not Salt) it dropped to completely normal and stayed that way for the last few days of the diet.
I was supplementing with the potassium because I get leg cramps and palpitations when I eat very low carb without potassium. This is because flushing out glycogen also triggers a loss of potassium. (This loss is measured in some studies as a rough gauge of how much glycogen has been lost.)
My lab results from last Wednesday when my blood pressure was 122/73 showed that my blood sodium level was at the very bottom of the normal range and potassium was in the middle of the normal range. This was reassuring, as I had a concern that the Captopril I take might cause my potassium levels to rise too high. I was not dehydrated, based on my normal BUN. In the past when eating LC I have almost always had a high BUN. Controlling protein might have helped there as did the potassium.
When I ended my diet and went back to eating normally, my blood pressure soared. As a further experiment I went back to supplementing with potassium, thanks to the suggestion one of you sent me, and today my blood pressure is back to being normal, at 114/74, as opposed to the 151/92 it was three days ago.
Since I had a lot of trouble with very high blood pressure while eating a very low carb diet in the past--the exact opposite of what the LC gurus claim happens--I'm starting to think that BP for me is all about those potassium levels. Low carb diets can be very high in sodium and potassium deficient, and that may be why I had so much trouble with blood pressure eating a long-term low carb diet.
Blood Sugar
My blood sugars had continued to be beautiful--in the 70s and low 80s at all times. So it was daunting to discover that the lab said my blood sugar was 92 mg/dl when my meter said it was 83 mg/dl. This means that the FreeStyle Lite meter that my insurer forces me to use reads low. So it's probable that my 70s were really 80s and 80s were 90s. It also means my occasional 140s were probably really 150s.
My A1c was 5.5%, which is .2% lower than usual. Some of the drop is due to the low carbing I'd done during the previous 2 weeks. Though doctors think that the A1c reflects the control of the last 3 months, this is not entirely true. The A1c most strongly reflects the blood sugar control during the previous 2 weeks, with the rest of the past experience only making a smaller contribution.
My A1cs are always higher than predicted by my average meter readings, and this one is no different. I attribute this to the likelihood that my red blood cells are living longer than average which will raise how much glucose has become bonded to them. It is that, not actual blood sugar levels, that the A1c measures.
Mood and Energy
By the end of my diet I felt like absolute crap. I wasn't sleeping well and was having the vibrant dreams that happen early on in a ketogenic diet, but there was no sign of the energy burst I usually experience at that phase of an low carb diet. This may be a result of how low my calories had to be for me to lose weight.
Whatever the explanation, I felt exhausted and depressed, and just walking around was a challenge. As soon as my diet was complete and I raised my carbs back to their usual level I felt like my old self with much better energy.
I was very hungry throughout the last week, too, even though my fat intake was reasonably high and my blood sugars completely flat.
Because my blood sugars are very well controlled right now I did not get into binging once I stopped my diet and started eating carbs again. In fact, I had a couple days when I was very busy with a new project over the past few days where I didn't end up eating all that much. This verified my belief that, for me, when I am eating carbs, hunger is entirely about how high my blood sugars surge. Right now they aren't surging very high even when I eat 20-30 g of carbs per meal, so I'm not experiencing blood sugar-caused hunger.
In the past eating a very low carb diet for a few weeks has given me decent energy and no hunger, but I wasn't limiting calories. However, throughout the past 5 years when I've done a very low carb diet not counting calories, I haven't lost an ounce of real weight.
Miscellaneous Observations
I ended up having a lot of heartburn on this diet. Peanut butter and Greek yogurt both caused it. Cheese did not (ruling out that I'm sensitive to dairy, per se.) When I went back to eating gluten at the end of the diet I did not experience heartburn. There doesn't seem to be any reason for me to go gluten free.
Conclusions
Calories count. My nutritional calculator is pretty accurate. It is extremely hard to find low carb foods that meet the caloric target I have to hit to lose weight without boosting protein too high.
This diet confirmed that for me to lose any weight at my age (64) and size (5' 3 and 144 lbs) I'd have to eat no more than 1250 calories a day to lose 2 lbs a month, even on a low carb diet, which for me would be an unsustainable starvation diet.
So my conclusion is that my weight loss diet days are over and that now that I'm heading into my misnamed "golden years" I better get used to carrying a bit more weight because the alternative is a starvation lifestyle.
Fortunately, there is a solid body of research suggesting that the healthiest weight for people my age and older skews towards the "overweight" category (BMI of 25 and a bit higher).
What this may mean for you is that the time to lose weight is when you are in your 30s, 40s, and 50s, when you burn more calories just breathing and walking around. Our metabolic rate drops with each decade we survive--even with exercise--so it gets tougher to lose weight as we get older.
Low carb diets are very effective for people with a lot of weight to lose whose caloric needs are much higher, but their main advantage in respect to weight loss is that when people cut out carbs they cut out all the high caloric junk that is what caused them to gain weight in the first place. If you control protein it becomes much tougher to overeat on a low carb diet, too.
The true virtue of low carb diets is, of course, that they control blood sugar very well. If my current blood sugar-control regimen stops working, I know that cutting back on carbs will drop my blood sugar (as long as I have functional beta cells, which fortunately, seems to be the case.)
Comments?
NOTE: In response to a point brought up in one of the comments it's worth noting that after Thanksgiving I did 10 days of a classic "Don't count anything but carbs" diet. In contrast to what happened with the calorie controlled low carb diet described above, I lost a grand total of 2 lbs during the "all you can eat" LC diet which came back when I raised carbs out of the ketogenic range. I was spilling urinary ketones from day 3 to day 10. Blood sugar and blood pressure were normal on that diet (after a rocky first few days for the blood pressure, again) but as has been the case for me for the past 5 years, a ketogenic low carb diet without caloric restriction is worthless for weight loss.
-----
* I used the body fat percentage my Tanita scale provides when using the calculator to estimate intake. If I omitted the body fat percentage, the calculator would tell me that I would have to eat a starvation diet to lose 1 lb a week, which it won't provide numbers for.
October 1, 2012
More Adventures in Very Low Carb Dieting
So this morning begins the second week of my very low carb diet experiment. Here's what LifeForm has to say about what I ate.
Sodium: 1568 mg
Vitamin A: 112%
Vitamin C: 95%
Calcium 83%
Iron 27%
Since I only ate one meal away from home, I was able to weigh all my portions and use label information.
The low iron is fine. Too much iron is a problem for many of us with diabetes and many older people. Since I dumped my cast iron cooking pan, when tested mine is always normal. If it dropped, the cast iron pan would quickly solve that problem.
My weight this morning was 142.4. lbs
My average fasting weight for the past week was 144.0
This average doesn't include my morning weight the day that I started the diet.
This represents a loss of 2.3 lbs since the morning after my first full day of dieting. (I did not use my starting weight as it was artificially high thanks to having eaten a very salty meal the previous day.)
Boring Food Does Make It Easier to Diet
As I mentioned in an earlier post, I have been home-testing Stephan Guyenet's palatability thesis. So far it looks like he may have a point. One huge benefit of eating almost the same food every day and doing no cooking fancier than frying up an egg or baking a chicken is that it cuts way down on thinking about food.
A few days ago I stopped in to visit one of the active low carb forums (one that banned me a few years ago, most likely for telling the truth about the bogus "low carb" crap the site owner sells.) The main thing that struck me was how obsessed with food all the posts were. Everyone was posting recipes, many of them extremely high in calories, and often they were for cakes, desserts, and candy-like treats. Just reading the site made me start craving food.
Bad!
The rest of the time when I knew exactly what I was going to be eating I did not think about food until it was time to eat my [tiny] meal. No way was I going to be slavering thinking about eggs with cheese for breakfast, salad with meat and cheese for lunch, yogurt with sunflower seeds for dinner.
Thinking about food may in fact get the brain secreting hormones that change our metabolism in ways that fight weight loss.
Take Away Lesson: Though variety is essential for maintaining a low carb lifestyle, and also likely to be very important for sustaining a successful diet phase, it might be a very good strategy to eat one set group of foods each week and only research (and shop) for the next week's foods during a short period of time. Look at the recipe sites and cookbooks before you start your weight loss diet--or while you are maintaining.
More Thoughts on Glycogen
When I started this experiment I was taking 1000 mg of metformin every day. I had to stop taking it mid-week because my blood sugars were so low that I didn't need even the small lowering that metformin produces.
After the first day's loss--which was likely mostly salt from that Vietnamese lunch, I didn't lose anything for about 4 days, then I dropped another couple pounds. I have often observed that metformin blocks the early loss of glycogen that occurs when I eat a ketogenic diet. My guess is that stopping the metformin allowed me to lose more glycogen.
I'm starting to think that metformin somehow "locks" the liver glycogen which is why it can be so helpful in lowering fasting glucose. But it also means you can't lose glycogen when you are in a ketogenic state. Since that stored glycogen isn't accessible when you take metformin, this isn't an issue, but it can make for odd patterns of weight loss.
In any event, as gratifying as the number on the scale my be most of the weight loss is glycogen and will come back when I eat more than 70 grams of glucose (my own personal ketogenic threshhold. Many people's are higher because they are larger than me.) I maintain around 100 g a day, so I won't really know how much fat I lost for a while.
NOTE: If you don't understand what glycogen is and the role it plays in weight loss this topic is covered extensively in my book Diet 101: The Truth About Low Carb Diets. You'll find a brief summary online HERE.
Ketones
I was turning ketone strips pink all the time, mostly "small", with one "moderate" and one "light" reading. Interestingly the "light" reading occurred when I was feeling really hungry and before a drop in scale weight. Perhaps that is a sign I was burning newly freed-up glycogen as the metformin wore off.
Hunger
I had long periods when I wasn't hungry, but noticed that I did get hungry--often very hungry--in the evening 4 or 5 hours after my last meal. (No snacks on this diet!) I resorted to the "Two Gram Cure" and it worked. When I tested my blood sugar at these hungry time it was usually in the 70s.
This confirms my belief that for me, at least, it is blood sugar level that causes hunger.
Wheatlessness
Since my blood sugar normalized on the Coenzyme Q10 I have been eating quite a lot of wheat. I went completely grain free this week, but so far I can't say that I noticed any of the magical changes claimed for going wheat or gluten free.
I don't have any of the kinds of antibodies associated with gluten allergy nor do I have any history or family history of autoimmune disease, so this is predictable. I still had some heart burn, mostly because yogurt causes me to have heart burn.
Blood Pressure
It's up, sadly. This often happens when I eat a very low carb diet, contrary to the "one-size-fits-all" claims of those who make millions selling diet hope. After one day when it dropped, it went right back up and was alarmingly high another morning, though responsive to medication (captopril). Some of this may have to do with it getting cold here on our windy hilltop and my refusing to turn on the heat (expensive oil) while the calendar read "September." Cold will raise blood pressure, but probably not as much as mine is rising.
Blood Sugar
Fasting this morning was 83 mg/dl, again suggesting that the metformin is wearing off. Post meals it is dropping into the 70s. For the last thee mornings my fastings were in the 70s.
Energy Level
Not great, in fact, I've been really droopy much of the time. I have had some trouble sleeping and I have been having those very vibrant dreams that often come with ketosis.
Plans for This Week
I'm going to stay in ketosis this week but raise my calories to 1250 as I don't think starvation diets are smart. The extra calories will be fat. Not having me eat with him is a stress for my Sweetie, who, as men are prone to do, has lost more weight simply because he is having to get his own meals and we aren't doing any social eating, than I am eating like an anorectic bird.
I'm remembering the social toll that is taken by not making meals a major part of socializing. I will be glad to get back to my usual regimen, hopefully having eliminated the carb creep that happened over this past summer. I'd like to stay maintaining at my usual 100-110 g a day level and 1600 calories a day (which is a tad higher than what the calculator says I should eat, but is what I can eat without feeling like I'm starving myself.)
Comments?
Sodium: 1568 mg
Vitamin A: 112%
Vitamin C: 95%
Calcium 83%
Iron 27%
Since I only ate one meal away from home, I was able to weigh all my portions and use label information.
The low iron is fine. Too much iron is a problem for many of us with diabetes and many older people. Since I dumped my cast iron cooking pan, when tested mine is always normal. If it dropped, the cast iron pan would quickly solve that problem.
My weight this morning was 142.4. lbs
My average fasting weight for the past week was 144.0
This average doesn't include my morning weight the day that I started the diet.
This represents a loss of 2.3 lbs since the morning after my first full day of dieting. (I did not use my starting weight as it was artificially high thanks to having eaten a very salty meal the previous day.)
Boring Food Does Make It Easier to Diet
As I mentioned in an earlier post, I have been home-testing Stephan Guyenet's palatability thesis. So far it looks like he may have a point. One huge benefit of eating almost the same food every day and doing no cooking fancier than frying up an egg or baking a chicken is that it cuts way down on thinking about food.
A few days ago I stopped in to visit one of the active low carb forums (one that banned me a few years ago, most likely for telling the truth about the bogus "low carb" crap the site owner sells.) The main thing that struck me was how obsessed with food all the posts were. Everyone was posting recipes, many of them extremely high in calories, and often they were for cakes, desserts, and candy-like treats. Just reading the site made me start craving food.
Bad!
The rest of the time when I knew exactly what I was going to be eating I did not think about food until it was time to eat my [tiny] meal. No way was I going to be slavering thinking about eggs with cheese for breakfast, salad with meat and cheese for lunch, yogurt with sunflower seeds for dinner.
Thinking about food may in fact get the brain secreting hormones that change our metabolism in ways that fight weight loss.
Take Away Lesson: Though variety is essential for maintaining a low carb lifestyle, and also likely to be very important for sustaining a successful diet phase, it might be a very good strategy to eat one set group of foods each week and only research (and shop) for the next week's foods during a short period of time. Look at the recipe sites and cookbooks before you start your weight loss diet--or while you are maintaining.
More Thoughts on Glycogen
When I started this experiment I was taking 1000 mg of metformin every day. I had to stop taking it mid-week because my blood sugars were so low that I didn't need even the small lowering that metformin produces.
After the first day's loss--which was likely mostly salt from that Vietnamese lunch, I didn't lose anything for about 4 days, then I dropped another couple pounds. I have often observed that metformin blocks the early loss of glycogen that occurs when I eat a ketogenic diet. My guess is that stopping the metformin allowed me to lose more glycogen.
I'm starting to think that metformin somehow "locks" the liver glycogen which is why it can be so helpful in lowering fasting glucose. But it also means you can't lose glycogen when you are in a ketogenic state. Since that stored glycogen isn't accessible when you take metformin, this isn't an issue, but it can make for odd patterns of weight loss.
In any event, as gratifying as the number on the scale my be most of the weight loss is glycogen and will come back when I eat more than 70 grams of glucose (my own personal ketogenic threshhold. Many people's are higher because they are larger than me.) I maintain around 100 g a day, so I won't really know how much fat I lost for a while.
NOTE: If you don't understand what glycogen is and the role it plays in weight loss this topic is covered extensively in my book Diet 101: The Truth About Low Carb Diets. You'll find a brief summary online HERE.
Ketones
I was turning ketone strips pink all the time, mostly "small", with one "moderate" and one "light" reading. Interestingly the "light" reading occurred when I was feeling really hungry and before a drop in scale weight. Perhaps that is a sign I was burning newly freed-up glycogen as the metformin wore off.
Hunger
I had long periods when I wasn't hungry, but noticed that I did get hungry--often very hungry--in the evening 4 or 5 hours after my last meal. (No snacks on this diet!) I resorted to the "Two Gram Cure" and it worked. When I tested my blood sugar at these hungry time it was usually in the 70s.
This confirms my belief that for me, at least, it is blood sugar level that causes hunger.
Wheatlessness
Since my blood sugar normalized on the Coenzyme Q10 I have been eating quite a lot of wheat. I went completely grain free this week, but so far I can't say that I noticed any of the magical changes claimed for going wheat or gluten free.
I don't have any of the kinds of antibodies associated with gluten allergy nor do I have any history or family history of autoimmune disease, so this is predictable. I still had some heart burn, mostly because yogurt causes me to have heart burn.
Blood Pressure
It's up, sadly. This often happens when I eat a very low carb diet, contrary to the "one-size-fits-all" claims of those who make millions selling diet hope. After one day when it dropped, it went right back up and was alarmingly high another morning, though responsive to medication (captopril). Some of this may have to do with it getting cold here on our windy hilltop and my refusing to turn on the heat (expensive oil) while the calendar read "September." Cold will raise blood pressure, but probably not as much as mine is rising.
Blood Sugar
Fasting this morning was 83 mg/dl, again suggesting that the metformin is wearing off. Post meals it is dropping into the 70s. For the last thee mornings my fastings were in the 70s.
Energy Level
Not great, in fact, I've been really droopy much of the time. I have had some trouble sleeping and I have been having those very vibrant dreams that often come with ketosis.
Plans for This Week
I'm going to stay in ketosis this week but raise my calories to 1250 as I don't think starvation diets are smart. The extra calories will be fat. Not having me eat with him is a stress for my Sweetie, who, as men are prone to do, has lost more weight simply because he is having to get his own meals and we aren't doing any social eating, than I am eating like an anorectic bird.
I'm remembering the social toll that is taken by not making meals a major part of socializing. I will be glad to get back to my usual regimen, hopefully having eliminated the carb creep that happened over this past summer. I'd like to stay maintaining at my usual 100-110 g a day level and 1600 calories a day (which is a tad higher than what the calculator says I should eat, but is what I can eat without feeling like I'm starving myself.)
Comments?
September 28, 2012
Walking the Low Carb Walk
After participating in the low carb call-in show and hearing from so many dieters there and in the email the show provoked, I started thinking it might be interesting to do a stint of very low carb dieting myself, just to see if I noticed anything new, now that I've done so much research.
Though I ate a very strict low carb diet for many years, I have been eating under 110 grams a day since 2009, largely because the medication choices I'd made have made it possible to keep my blood sugars in better control at that level than at a lower one.
The last time I ate a ketogenic low carb diet was for about 5 months in 2008. Over that time my fasting blood sugar rose and I didn't lose any weight that didn't come right back when I boosted my carbs.
That was fine: I was eating that way to prepare for some surgery and promote healing afterwards, and since I healed up very quickly, it seemed to help. But once I was healed up, I decided there was no real point in eating a ketogenic diet since my main focus is on blood sugar control
Things are quite different now. My blood sugar is better than it has ever been, thanks to my very unusual response to a low dose of Coenzyme Q10. (I am currently exploring what might explain this and have called on an expert in oddball forms of diabetes to help me with this. I'll report on it if I learn anything that will be useful to others with odd forms of insulin-sensitive diabetes.)
But because I've been able to eat much more widely than I had been able to, even with insulin, I have been eating a lot these past few months, and though my scale weight was only up 2-3 lbs, my pants informed me that I had a choice: cut back a bit, or buy new pants. That's the kind of message I take seriously, so this past Monday I embarked on a new very low carb diet.
What Was Different This Time?
One thing that was different this time is that the work I did last year to upgrade my nutritional calculator using the most up-to-date formulas and taking into account body fat percentage yielded me more information about what it would take for me to lose weight. That meant that unless I wanted to diet for the next 6 months, losing the 3 real pounds I'd set as a weight goal meant cutting way back on calories to a level that ruled out any "luxuriant eating."
I decided to see what would happen if during the first week I ate following the guidelines that the calculator set for losing 1 lb a week. I used my bodyfat percentage as estimated by my Tanita scale, which gave me a slightly higher caloric intake than the calculator gives me when I omite body weight percentage. (That's because I truly do have a "large build" with very big leg muscles for a women--so big that even when I weighed 110 lbs I couldn't fit into those fashionable Frye Boots that everyone wore in the 1970s.)
The calculator told me that I could lose a pound a week eating roughly 1050 calories a day.
How Much Protein To Eat?
This posed one problem--was I to calculate how much protein I should eat based on the formula used for experienced low carbers, or should I use the formula for beginners that assumes that I would need a lot of extra protein to provide glucose to run my brain until it switched over to burning ketones?
At this low a calorie level, eating the extra protein would make it impossible to eat a safe low carb diet, because protein would use up all my calories leaving my fat intake dangerously low.
I decided to experiment and see if my body remembered how to burn ketones after my 7+ years of low carbing in the past and stick with a protein intake that while higher than my requirements while in a fully ketotic state was a lot lower than the amount needed for a newbie.
That seems to have been a good call. I'm on Day 5 and have been in Ketosis every time I have tested since Day 3 (based on testing with urine testing strips) except once after I ate some protein powder that seems to have had more carbs in it than the label claimed.
I haven't had any headache or other symptoms that come from adjusting to burning ketones. So apparently there is no need to eat any more than the amount of protein a long-term low carber would need.
How Much Glycogen-Associated and Water Weight Loss?
I lost 3.5 lbs within 24 hours of starting my diet. This suggests that much of my most recent weight gain was water weight, possibly from eating too much salty food. That is too short a time for me to have burned through three pounds worth of stored glycogen.
Since I have been taking metformin for years, I probably don't have a lot of stored glycogen left to burn. My experience in the past while low carbing while taking metformin is that I don't lose glycogen-related water weight. However, if I stop taking metformin, I regain what looks a lot like glycogen-related weight for the next week.
How Much Real Weight Loss?
After that first day's loss, I haven't lost any more weight. I weighed the same this morning as I did Tuesday morning. However, I don't really expect to see real weight loss occuring that quickly, since even if I am eating at a level that will result in a pound of real weight loss over a week after 4 days I would have only lost slightly more than .5 lbs, which is an amount easily hidden by salt-related fluctuations.
How's My Blood Sugar Reacting?
My fasting blood sugar was 91 mg/dl the morning before I started my diet. It dropped to 85 the next day and was 84 any time I tested it until this morning when I woke up at 76. An hour after lunch today it was again 76.
When I felt hungry, I used my 2 gram cure and it worked. I used it five times over the past 4 days, but never more than once within a 3 hour period.
What is the Impact on My Blood Pressure?
My blood pressure had risen the past two weeks, as it always does when the house chills down (I refuse to run the heat until October, but having adapted to 73 F all summer the mornings we experience that are 64-65 F takes some getting used to.)
My blood pressure dropped remained high on Day 1 and 2, then dropped quite dramatically, to normal on Day 3 and morning on Day 4. Then in the afternoon of Day 4 it shot up very high (163/89) after I experienced a burst of stress hormones. It was normal again on the morning of Day 5 (123/76).
I think the stress hormones were the result of either blood sugar or blood pressure dropping too low, generating a counterregulatory burst.
In the past when I ate LC I had several dramatic stints of very high blood pressure, contrary to what you read in the bestselling books. I will keep a closer watch on both sugars and BP to avoid the stress release as it feels rotten and takes 3 hours to abate.
What Am I Eating?
Not much! 1050 calories is such a low calorie intake that it's tricky getting enough protein without going overboard on the fat. All the usual low carb diet tricks that make low carbing enjoyable and sustainable are out. Bacon and cream cheese have too much fat for the protein they contribute. So I am pretty much testing Stephen Guyenet's theory that eating boring food helps us lose weight.
I'm using my food scale to weigh everything, and learning how fast those calories pile up. I'm also seeing how many of my "go to" low carb foods that I eat when I'm not trying to lose weight push my calorie intake way up--like the low carb cocoa I make with half and half or the bits of cheese I put in my salads.
That said, since with the exception of my experiment with the protein powder my blood sugars have been rock solid flat, I haven't been hungry except, sometimes, an hour or so after eating and about 9 P. After eating is when I've used the 2 gram cure. I'm thinking I probably ought to eat my last meal a bit later (I tend to eat dinner between 5:30 and 6 PM.) That might keep me from getting hungry right before I'm ready for sleep.
The foods I've been mainly eating are:
1 soup bowl full of romaine and/or baby spinach every day
1 small campari tomato
1 slice of fresh red pepper
home made olive oil and vinegar dressing with herbs
havarti cheese with dill in salad (from Trader Joe's)
1 egg with 1 oz munester or havarti cheese for breakfast
Protein shakes made with 1 scoop of protein
Supermarket rotisserie chicken ("all natural")
Trader Joe's uncured low salt pastrami
I was out one afternoon and ate pulled pork and saag paneer from the Whole Foods buffet.
Fage Greek yogurt, both 0% and 2% fat (since that was what was in the fridge.) I'm not having any trouble getting my fat up to target, so it will be 0% tonight
1 tbs of unsalted roasted sunflower seeds with the yogurt
Davinci White Chocolate Sugar Free Syrup with Splenda for sweetening cocoa and yogurt
Homemade low carb cocoa (Hershey's cocoa, Davinci syrup, and half and half)
decaf tea
decaf coffee 2 cups a day. I'm not avoiding caffeine for diet reasons, but caffeinated coffee
pushes up my blood pressure so I am not currently drinking it.
NOTE: The Six Star brand Vanilla Cream Protein Powder I bought at Walmart tasted revolting and raised my blood sugar. It took 20 minutes for the aftertaste to go away.
Highly NOT recommended.
Nutritional Breakdown
LifeForm tells me that my average daily intake for 5 days (including tonight's dinner) has been 1045 calories.
Fat: 63 g, 58%
Sat fat: 28 g, 26%
Carbs: 22 g
Fiber: 3 g (I am also taking a spoonful of no-sugar psyillium ever day)
Sugars: 14 g (this includes the sugar in the yogurt which I believe has been fermented
away)
Protein: 81 g 34% (My requirement to supply my brain after adapting to ketosis is only 63 g but I wanted some slack to avoid consuming muscle if I was wrong about the
retained ability to adapt.)
I'm not sure if this is interesting to anyone but me, so let me know if you want to hear more in the comments, where I'll also be happy to answer questions.
Though I ate a very strict low carb diet for many years, I have been eating under 110 grams a day since 2009, largely because the medication choices I'd made have made it possible to keep my blood sugars in better control at that level than at a lower one.
The last time I ate a ketogenic low carb diet was for about 5 months in 2008. Over that time my fasting blood sugar rose and I didn't lose any weight that didn't come right back when I boosted my carbs.
That was fine: I was eating that way to prepare for some surgery and promote healing afterwards, and since I healed up very quickly, it seemed to help. But once I was healed up, I decided there was no real point in eating a ketogenic diet since my main focus is on blood sugar control
Things are quite different now. My blood sugar is better than it has ever been, thanks to my very unusual response to a low dose of Coenzyme Q10. (I am currently exploring what might explain this and have called on an expert in oddball forms of diabetes to help me with this. I'll report on it if I learn anything that will be useful to others with odd forms of insulin-sensitive diabetes.)
But because I've been able to eat much more widely than I had been able to, even with insulin, I have been eating a lot these past few months, and though my scale weight was only up 2-3 lbs, my pants informed me that I had a choice: cut back a bit, or buy new pants. That's the kind of message I take seriously, so this past Monday I embarked on a new very low carb diet.
What Was Different This Time?
One thing that was different this time is that the work I did last year to upgrade my nutritional calculator using the most up-to-date formulas and taking into account body fat percentage yielded me more information about what it would take for me to lose weight. That meant that unless I wanted to diet for the next 6 months, losing the 3 real pounds I'd set as a weight goal meant cutting way back on calories to a level that ruled out any "luxuriant eating."
I decided to see what would happen if during the first week I ate following the guidelines that the calculator set for losing 1 lb a week. I used my bodyfat percentage as estimated by my Tanita scale, which gave me a slightly higher caloric intake than the calculator gives me when I omite body weight percentage. (That's because I truly do have a "large build" with very big leg muscles for a women--so big that even when I weighed 110 lbs I couldn't fit into those fashionable Frye Boots that everyone wore in the 1970s.)
The calculator told me that I could lose a pound a week eating roughly 1050 calories a day.
How Much Protein To Eat?
This posed one problem--was I to calculate how much protein I should eat based on the formula used for experienced low carbers, or should I use the formula for beginners that assumes that I would need a lot of extra protein to provide glucose to run my brain until it switched over to burning ketones?
At this low a calorie level, eating the extra protein would make it impossible to eat a safe low carb diet, because protein would use up all my calories leaving my fat intake dangerously low.
I decided to experiment and see if my body remembered how to burn ketones after my 7+ years of low carbing in the past and stick with a protein intake that while higher than my requirements while in a fully ketotic state was a lot lower than the amount needed for a newbie.
That seems to have been a good call. I'm on Day 5 and have been in Ketosis every time I have tested since Day 3 (based on testing with urine testing strips) except once after I ate some protein powder that seems to have had more carbs in it than the label claimed.
I haven't had any headache or other symptoms that come from adjusting to burning ketones. So apparently there is no need to eat any more than the amount of protein a long-term low carber would need.
How Much Glycogen-Associated and Water Weight Loss?
I lost 3.5 lbs within 24 hours of starting my diet. This suggests that much of my most recent weight gain was water weight, possibly from eating too much salty food. That is too short a time for me to have burned through three pounds worth of stored glycogen.
Since I have been taking metformin for years, I probably don't have a lot of stored glycogen left to burn. My experience in the past while low carbing while taking metformin is that I don't lose glycogen-related water weight. However, if I stop taking metformin, I regain what looks a lot like glycogen-related weight for the next week.
How Much Real Weight Loss?
After that first day's loss, I haven't lost any more weight. I weighed the same this morning as I did Tuesday morning. However, I don't really expect to see real weight loss occuring that quickly, since even if I am eating at a level that will result in a pound of real weight loss over a week after 4 days I would have only lost slightly more than .5 lbs, which is an amount easily hidden by salt-related fluctuations.
How's My Blood Sugar Reacting?
My fasting blood sugar was 91 mg/dl the morning before I started my diet. It dropped to 85 the next day and was 84 any time I tested it until this morning when I woke up at 76. An hour after lunch today it was again 76.
When I felt hungry, I used my 2 gram cure and it worked. I used it five times over the past 4 days, but never more than once within a 3 hour period.
What is the Impact on My Blood Pressure?
My blood pressure had risen the past two weeks, as it always does when the house chills down (I refuse to run the heat until October, but having adapted to 73 F all summer the mornings we experience that are 64-65 F takes some getting used to.)
My blood pressure dropped remained high on Day 1 and 2, then dropped quite dramatically, to normal on Day 3 and morning on Day 4. Then in the afternoon of Day 4 it shot up very high (163/89) after I experienced a burst of stress hormones. It was normal again on the morning of Day 5 (123/76).
I think the stress hormones were the result of either blood sugar or blood pressure dropping too low, generating a counterregulatory burst.
In the past when I ate LC I had several dramatic stints of very high blood pressure, contrary to what you read in the bestselling books. I will keep a closer watch on both sugars and BP to avoid the stress release as it feels rotten and takes 3 hours to abate.
What Am I Eating?
Not much! 1050 calories is such a low calorie intake that it's tricky getting enough protein without going overboard on the fat. All the usual low carb diet tricks that make low carbing enjoyable and sustainable are out. Bacon and cream cheese have too much fat for the protein they contribute. So I am pretty much testing Stephen Guyenet's theory that eating boring food helps us lose weight.
I'm using my food scale to weigh everything, and learning how fast those calories pile up. I'm also seeing how many of my "go to" low carb foods that I eat when I'm not trying to lose weight push my calorie intake way up--like the low carb cocoa I make with half and half or the bits of cheese I put in my salads.
That said, since with the exception of my experiment with the protein powder my blood sugars have been rock solid flat, I haven't been hungry except, sometimes, an hour or so after eating and about 9 P. After eating is when I've used the 2 gram cure. I'm thinking I probably ought to eat my last meal a bit later (I tend to eat dinner between 5:30 and 6 PM.) That might keep me from getting hungry right before I'm ready for sleep.
The foods I've been mainly eating are:
1 soup bowl full of romaine and/or baby spinach every day
1 small campari tomato
1 slice of fresh red pepper
home made olive oil and vinegar dressing with herbs
havarti cheese with dill in salad (from Trader Joe's)
1 egg with 1 oz munester or havarti cheese for breakfast
Protein shakes made with 1 scoop of protein
Supermarket rotisserie chicken ("all natural")
Trader Joe's uncured low salt pastrami
I was out one afternoon and ate pulled pork and saag paneer from the Whole Foods buffet.
Fage Greek yogurt, both 0% and 2% fat (since that was what was in the fridge.) I'm not having any trouble getting my fat up to target, so it will be 0% tonight
1 tbs of unsalted roasted sunflower seeds with the yogurt
Davinci White Chocolate Sugar Free Syrup with Splenda for sweetening cocoa and yogurt
Homemade low carb cocoa (Hershey's cocoa, Davinci syrup, and half and half)
decaf tea
decaf coffee 2 cups a day. I'm not avoiding caffeine for diet reasons, but caffeinated coffee
pushes up my blood pressure so I am not currently drinking it.
NOTE: The Six Star brand Vanilla Cream Protein Powder I bought at Walmart tasted revolting and raised my blood sugar. It took 20 minutes for the aftertaste to go away.
Highly NOT recommended.
Nutritional Breakdown
LifeForm tells me that my average daily intake for 5 days (including tonight's dinner) has been 1045 calories.
Fat: 63 g, 58%
Sat fat: 28 g, 26%
Carbs: 22 g
Fiber: 3 g (I am also taking a spoonful of no-sugar psyillium ever day)
Sugars: 14 g (this includes the sugar in the yogurt which I believe has been fermented
away)
Protein: 81 g 34% (My requirement to supply my brain after adapting to ketosis is only 63 g but I wanted some slack to avoid consuming muscle if I was wrong about the
retained ability to adapt.)
I'm not sure if this is interesting to anyone but me, so let me know if you want to hear more in the comments, where I'll also be happy to answer questions.
September 22, 2012
My Live Call-In Show with Jimmy Moore is Now a Podcast
You can now hear my latest interview with Jimmy Moore as a podcast. Find it HERE or download it on iTunes.
The topic was "Overcoming Low Carb Problems." Not surprisingly, most of the questions were about not losing weight.
As most of you know my take on the Low Carb diet is that it is an effective way to lower blood sugar. Flattening blood sugar makes us lose the raging hunger that makes so many people with diabetes and prediabetes overeat and gain. So when most people normalize their blood sugar and stop eating the high carb, high calorie junk foods that they used to rely on, they lose weight. Often a significant amount. For a while.
The data I've reviewed, and my years of participating in online diet discussion groups have convinced me that normal weight loss on a low carb diet goes through three phases. A quick weight loss phase where as much as 20 lbs can be lost within weeks--all glycogen, and not body fat, a slower phase lasting up to 6 months when weight comes off at a reasonable pace (a pound a week, for example) and the final phase where weight loss slows to the point where many people can't detect it, get discouraged and quit, though in fact if they stick to the diet they'll lose 1/2 a pound or a pound a month for quite a while longer.
Some people have better results, but since these are the average, for everyone who does better, someone does worse. This isn't because they're doing it wrong--though the doctors who profit mightily from selling magical diet dreams often use that as the explanation for why their magical diets fail real people. These conclusions are supported by lots of academic research and the testimony of decades' worth of online dieters, including that of the small group of people honest enough to admit that their diets haven't lived up to their hopes even when they've pursued them religiously.
Many people have a false idea of how their weight loss should proceed on a low carb diet because the online Low Carb and Paleo cultures are dominated by young, fit men, and doctors whose only experience of weight loss is knocking off 10 or 20 pounds in middle age. You rarely hear the voices of older women and those with serious metabolic problems. (Jimmy is a refreshing exception to this rule, but he's also an outlier. Very few people lose 200 lbs their first year on this or any other diet.)
So newbie dieters in the latter categories often assume that they will experience the same results as these vocal, young, healthy proponents of the diet who can lose steadily eating 2500 calories worth of delicious high fat food every day. But this ignores the fact that a 220 lb 35 year old man with a healthy metabolism may easily be able to lose weight while eating twice as much food as a 200 lb 55 year old woman. No matter how often that woman goes to the gym or how low her carb intake.
That's why many of the questions on this call in show were from older women and people with metabolic issues who thought there was something wrong with them when they couldn't lose on the kind of regimen that works for the outspoken, young, male proponents of these diets.
There isn't. For most older women with serious weight problems, losing weight means cutting way down on calories no matter what the macronutrient composition of their meals, and even then, weight loss will be slow--half a pound a month is not unusual after the first five or six months. Cutting carbs eliminates the appetite problem that make it so tough to cut back on food, but cutting carbs without cutting calories only works during the heady first few weeks and months of the diet. After that, it's time to get out the food scale, weigh portions, look up the nutritional value of what's on your plate, figure out how much your body burns daily, and eat significantly less than that amount every day for months and perhaps years to come.
This argument explains why my book Diet 101: The Truth About Low Carb Diets isn't a runaway bestseller. But it also explains why it's getting rave reviews on Amazon from people who say things like, "No BS here, folks" and " It was almost shocking to read a book that was completely honest on this subject -- no pie in the sky promises, just realistic statements and expectations supported by fact."
Another issue I discuss in response to questions on this live show was something the diet and weight loss surgery do their best to keep you from learning: most people never get to their diet goals, even when they amputate their stomachs and make it impossible to eat anything but an ultra low carb/low food diet.
I dug in and looked at some stats from WLS studies and found that a surprising number of people did not lose more than 50% of their excess weight even on these extreme regimens that force people to eat low carb. At best, most people lose 80% of their excess weight. If that's the best people can do on a forced ultra low carb/low food diet, it makes sense that a free range low carb diet is not going to get most people to their weight loss goal--because most people's weight loss goals, when they start out very overweight, are simply not realistic.
My own experience with polling the Low Carb community is that while there are some lucky people who do get to their goals, they are few in number. Most people lose 20% of their starting and then weight loss slows way, way down. If they stick to it, some can lose more, but if they push too hard, some end up with weight losses that can only be maintained by staying on a very rigid, low calorie diet for the rest of their lives. It's much harder to maintain on that kind of stringent regimen than it is on one that lets you feel like you're eating a reasonable amount of food.
That's why I often advise people to lose what you can lose without starving yourself, then work on maintaining that loss. Appreciate your victories. If you've normalized your blood sugar you won't end up with diabetic complications, even if you still weigh more than you'd like. Focus on maintaining what you have lost, however much it is. Maintaining a modest weight loss for a decade or more is a huge achievement--far healthier, harder, and more impressive than losing a lot of weight and regaining it all five years after your weight loss effort began.
All this is discussed in this podcast, but if you want to go into any of these topics in depth, I'd suggest reading my book, Diet 101: The Truth About Low Carb Diets. If you only get the simplified, pre-chewed version of diet advice that fits onto a web page or an interview, you will never learn all you need to know to truly understand your metabolism. We live in a society that caters to those who are too lazy to dig in, read, study and think. But it is by doing just that that you'll put yourself in a situation where you won't have to ask any expert or rely on their advice no matter how wierd, because you'll have the tools needed to evaluate all claims and chose the health strategies most likely to work for you in your own, individual circumstances.
The topic was "Overcoming Low Carb Problems." Not surprisingly, most of the questions were about not losing weight.
As most of you know my take on the Low Carb diet is that it is an effective way to lower blood sugar. Flattening blood sugar makes us lose the raging hunger that makes so many people with diabetes and prediabetes overeat and gain. So when most people normalize their blood sugar and stop eating the high carb, high calorie junk foods that they used to rely on, they lose weight. Often a significant amount. For a while.
The data I've reviewed, and my years of participating in online diet discussion groups have convinced me that normal weight loss on a low carb diet goes through three phases. A quick weight loss phase where as much as 20 lbs can be lost within weeks--all glycogen, and not body fat, a slower phase lasting up to 6 months when weight comes off at a reasonable pace (a pound a week, for example) and the final phase where weight loss slows to the point where many people can't detect it, get discouraged and quit, though in fact if they stick to the diet they'll lose 1/2 a pound or a pound a month for quite a while longer.
Some people have better results, but since these are the average, for everyone who does better, someone does worse. This isn't because they're doing it wrong--though the doctors who profit mightily from selling magical diet dreams often use that as the explanation for why their magical diets fail real people. These conclusions are supported by lots of academic research and the testimony of decades' worth of online dieters, including that of the small group of people honest enough to admit that their diets haven't lived up to their hopes even when they've pursued them religiously.
Many people have a false idea of how their weight loss should proceed on a low carb diet because the online Low Carb and Paleo cultures are dominated by young, fit men, and doctors whose only experience of weight loss is knocking off 10 or 20 pounds in middle age. You rarely hear the voices of older women and those with serious metabolic problems. (Jimmy is a refreshing exception to this rule, but he's also an outlier. Very few people lose 200 lbs their first year on this or any other diet.)
So newbie dieters in the latter categories often assume that they will experience the same results as these vocal, young, healthy proponents of the diet who can lose steadily eating 2500 calories worth of delicious high fat food every day. But this ignores the fact that a 220 lb 35 year old man with a healthy metabolism may easily be able to lose weight while eating twice as much food as a 200 lb 55 year old woman. No matter how often that woman goes to the gym or how low her carb intake.
That's why many of the questions on this call in show were from older women and people with metabolic issues who thought there was something wrong with them when they couldn't lose on the kind of regimen that works for the outspoken, young, male proponents of these diets.
There isn't. For most older women with serious weight problems, losing weight means cutting way down on calories no matter what the macronutrient composition of their meals, and even then, weight loss will be slow--half a pound a month is not unusual after the first five or six months. Cutting carbs eliminates the appetite problem that make it so tough to cut back on food, but cutting carbs without cutting calories only works during the heady first few weeks and months of the diet. After that, it's time to get out the food scale, weigh portions, look up the nutritional value of what's on your plate, figure out how much your body burns daily, and eat significantly less than that amount every day for months and perhaps years to come.
This argument explains why my book Diet 101: The Truth About Low Carb Diets isn't a runaway bestseller. But it also explains why it's getting rave reviews on Amazon from people who say things like, "No BS here, folks" and " It was almost shocking to read a book that was completely honest on this subject -- no pie in the sky promises, just realistic statements and expectations supported by fact."
Another issue I discuss in response to questions on this live show was something the diet and weight loss surgery do their best to keep you from learning: most people never get to their diet goals, even when they amputate their stomachs and make it impossible to eat anything but an ultra low carb/low food diet.
I dug in and looked at some stats from WLS studies and found that a surprising number of people did not lose more than 50% of their excess weight even on these extreme regimens that force people to eat low carb. At best, most people lose 80% of their excess weight. If that's the best people can do on a forced ultra low carb/low food diet, it makes sense that a free range low carb diet is not going to get most people to their weight loss goal--because most people's weight loss goals, when they start out very overweight, are simply not realistic.
My own experience with polling the Low Carb community is that while there are some lucky people who do get to their goals, they are few in number. Most people lose 20% of their starting and then weight loss slows way, way down. If they stick to it, some can lose more, but if they push too hard, some end up with weight losses that can only be maintained by staying on a very rigid, low calorie diet for the rest of their lives. It's much harder to maintain on that kind of stringent regimen than it is on one that lets you feel like you're eating a reasonable amount of food.
That's why I often advise people to lose what you can lose without starving yourself, then work on maintaining that loss. Appreciate your victories. If you've normalized your blood sugar you won't end up with diabetic complications, even if you still weigh more than you'd like. Focus on maintaining what you have lost, however much it is. Maintaining a modest weight loss for a decade or more is a huge achievement--far healthier, harder, and more impressive than losing a lot of weight and regaining it all five years after your weight loss effort began.
All this is discussed in this podcast, but if you want to go into any of these topics in depth, I'd suggest reading my book, Diet 101: The Truth About Low Carb Diets. If you only get the simplified, pre-chewed version of diet advice that fits onto a web page or an interview, you will never learn all you need to know to truly understand your metabolism. We live in a society that caters to those who are too lazy to dig in, read, study and think. But it is by doing just that that you'll put yourself in a situation where you won't have to ask any expert or rely on their advice no matter how wierd, because you'll have the tools needed to evaluate all claims and chose the health strategies most likely to work for you in your own, individual circumstances.
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